August 18, 2014

What Is the Future of the AADE?

Is there a future for the American Association of Diabetes Educators (AADE)? Not if the Academy of Certified Diabetes Educators (ACDE) has anything to say about it. At present they both have members that have taken the test given by the National Certification Board for Diabetes Educators (NCBDE) and passed it. The ACDE is taking the exclusive route and not allowing honorary membership and is lobbying hard in some states to prohibit anyone with knowledge of diabetes from passing this on to other people with diabetes. This includes peer-to-peer diabetes workers, peer diabetes mentors, diabetes coaches, and others.

The AADE does have honorary members and does unofficially work with a few of the groups in the last sentence above. And the AADE does not list all that have passed the NCBDE examination as members. The about 13,000 members does become more realistic when you consider those that have retired or are not doing certified diabetes education work. Although neither organization is particularly transparent in their actions, from my observations the AADE is the more transparent of the two.

Now I will take a blog by one of theAADE members posted on the AADE website and discuss the points made in the blog. You may read the points here.

“•We should keep moving forward with our public awareness campaign to increase media exposure highlighting what we do for people with diabetes (PWD). Rather than relying on a healthcare provider to recommend diabetes self-management education and support (DSME/S), let PWD know about what we do so they can ask for a referral (similar to what patients do regarding medications after they read or hear about something new).”

False advertising is not what they should be doing. This is the aim of Big Pharma in their advertising and the hypochondriacs answer the call. There has to be some reason that healthcare providers stop referring diabetes patients to CDEs. I know some doctors do not like the conflicts created by CDEs and this is why many will no longer refer diabetes patients. In other more rural areas, CDEs are just not available. When CDEs teach to the lowest level, make mandates the rule and do little actual education, then we must wonder if they have a purpose. Even many studies find that peer-to-peer education produces better A1cs.

“•When considering the value of diabetes education/educators, recognition should be given to what we prevent including the onset of diabetes, complications from diabetes, and costs (i.e., to prevent hospital admissions).”

Oh, if only this last could be true! The CDEs generally do not work with people with pre-diabetes or counsel them. Very few ever work with type 2 diabetes patients; therefore, I have to wonder with so few CDEs, how can we depend on these people to really fulfill the needs of so many. Most CDEs do not properly assess persons with diabetes (PWD). For many it is a one-size-fits-all or nothing. Many will not work with a PWD that talks about depression and most avoid dealing with depression or burnout. How can patients trust CDEs that avoid something like mild depression.

“•Diabetes education should be at the beginning of the algorithm for care of a person with diabetes; not at the middle or end when problems could have already occurred.”

The above is true, but there are not enough CDEs to take this on. Most will not work with telemedicine or groups of patients.

“•Diabetes educators are key providers in chronic care; we should brand our profession to be included in the chronic care model.”

Diabetes is a chronic illness, but with the few CDEs, how can we depend on CDEs to fill this role. Mandates do not work for people with diabetes and we need individual treatment, not the one-size-fits-all treatment they dish out.

“•Diabetes educators need to be armed with more knowledge on the business of diabetes to help us in the current medical care environment (i.e., Patient-Centered Medical Homes, Accountable Care Organizations, etc.).”

Many CDEs are learning that doctors are excluding them from the new medical care environment because of their attitudes.

“•We need to get legislators on our side to push through legislation that will help us in our work with PWD.”

This statement can be taken several ways and is open for interpretation. We have one organization doing this now and we don't need another organization trying to criminalize people for helping others with diabetes.

“•Diabetes educators can collaborate with more money-generating pieces of medical care so we can give quality care to PWD in a team approach (rather than struggling financially on our own and being considered a money-losing part of care).”

They do have a lot to learn.

“•We should clarify the levels of the diabetes educator so it is understood by us, healthcare providers, and the public.”

What levels are they talking about? The levels of mandates, maybe. Or those that run from people with depression? Now if they have different levels of education and training, maybe we should know this.

“•Many people with prediabetes may not appreciate the importance of behavior change to prevent the onset of type 2 diabetes. Perhaps prediabetes should be renamed Stage 1 diabetes to increase the importance of the condition and changes that can be made to prevent progression to DM (Stage 2 diabetes).”

This is one point I could support.
“•We should look for ways to influence the prevention of type 2 diabetes, from children to adults, with methods that can be accessed by all in need (including those with socio-economic challenges).”

No comments.

“•Electronic medical records give challenge and benefit. Diabetes educators should be at the table during the creation of EMRs to improve ease of use and beneficial data output.”

They are a way behind on this one. EMRs have already been created and are being updated all the time.

“•There are not enough diabetes educators to meet the needs of all PWD that could benefit from DSME/S. We need to get the word out about diabetes education in academic programs and to current healthcare providers that might be interested in becoming diabetes educators. At the same time, we need to increase the public’s knowledge of how we can help, increasing referrals to prevent closing of programs (and back to the knowledge about the business of DSME/S).”

The first sentence is correct, and the rest is a pipe dream as some are interested until they find out about the test and the qualifications needed.

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